Epistaxis or Nosebleed: Symptoms, Causes, Treatment, Prevention

Reviewed By: Pramod Kerkar, MD, FFARCSI

About Epistaxis or Nosebleed

The nose has rich vascular supply and because its location i.e. it protrudes from our face, it is more prone to injury or trauma leading to Epistaxis or nosebleed or bloody nose. The episode of Epistaxis or Nosebleed may be mild or severe. In dry climates or winter season where the air is dry due to heaters at home, the nasal membranes get dry and crack resulting in Epistaxis or Nosebleed. People who are taking blood thinners such as warfarin (Coumadin), aspirin or any other anti-inflammatory medication are more prone to Epistaxis or Nosebleed. In these patients, even the slightest impact to the nose causes profuse nosebleeds. Epistaxis or Nosebleeds also commonly occur after an impact or trauma to the nose or face. It may be accompanied with a fracture or they can occur after minor injuries. Sometimes Epistaxis or Nosebleeds can occur spontaneously without any trauma. Majority of the nosebleeds can be stopped at home with conservative measures.

Symptoms of Epistaxis or Nosebleed

One of the common symptoms of Epistaxis or Nosebleeds is that bleeding can occur from either one or both the nostrils.

The flow of the blood can be mild to severe.

The duration of Epistaxis or Nosebleeds may last for a few seconds to 10 minutes or even more.

During the episode of bleeding from Nose, the blood may travel down to the throat causing symptoms of nausea.

Serious Symptoms of Epistaxis or Nosebleed

If the bleeding from nose is profuse and cannot be stopped, it is a case of medical emergency.

If the blood loss is huge during the episode of Epistaxis or Nosebleed.

Causes of Epistaxis or Nosebleed

Impact or trauma to the nose resulting in rupture of the small blood vessels in the nose commonly causes Epistaxis or Nosebleed. If the impact or trauma to the nose is severe, then the nose should be examined for a fracture so that the airways are not blocked.

Epistaxis or Nosebleeds can also occur if a person blows the nose very hard or has a habit of picking the nose. This causes damage to the small blood vessels present in the walls of the nose causing minor nosebleeds.

Bleeing from nose can also be caused spontaneously, without any impact/trauma to the face.

Snorting recreational drugs is also known to cause Epistaxis or Nosebleed.

Infection.

Hypertension can also the blood vessels in the nose to rupture causing Epistaxis or Nosebleed.

Allergic and non-allergic rhinitis.

Alcohol abuse.

Use of blood thinners.

Bleeding from nose can also be caused due to tumors in the nose

Hormonal changes during pregnancy

Treatment to Stop Epistaxis or Nosebleeds

One of the simple treatment to stop nosebleed is to pinch the soft parts of the nose located below the bony part of the nose.

Patient having episode of Epistaxis should be made to sit down with the head tilted forwards in order to prevent the blood from traveling down to the sinuses and throat.

It is important that patients suffering from Nosebleed do not breathe through nose, but breathe through the mouth.

Continue pinching the nose for at least 20 minutes while checking the bleeding every 5 minutes.

Keep your head above the heart level. Do not put your head between your legs or lie flat.

One of the best treatment for Epistaxis or Nosebleed is ice application to the nose and face which is effective in reducing the bleeding and pain.

Medical attention should be sought immediately if bleeding from nose doesn't stop after 20 minutes and is heavy.

After the bleeding subsides, do not touch the nose, do not blow the nose, and avoid quick movements of the head for at least 12 hours after the bleeding has stopped.

If patient suffers from spontaneous nosebleeds without any trauma to the nose, then medical attention should be sought immediately as that could be sign of ruptured blood vessels in the nose which could be due to high blood pressure.

If the conservative treatments for Epistaxis or Nosebleed do not help then the doctor may use nasal packs to stop them.

Prevention of Epistaxis or Nosebleed

After an episode of Epistaxis or Nosebleed, rest with your head elevated at 30 to 45 degrees.

Avoid blowing your nose or putting anything in it. When sneezing, open your mouth to enable the air to escape from the mouth instead of the nose so as to prevent another episode of Epistaxis or Nosebleed.

Avoid straining during bowel movements. Include lot of fiber in your diet and use a stool softener such as docusate.

A lubricating ointment can be used inside the nose prescribed by a doctor.

If there is re-bleeding, you can clear the clots by sniffing in forcefully. Nasal decongestant sprays such as Afrin or Neo-Synephrine may provide temporary relief. These sprays can be addictive and should be avoided if the patient suffers from hypertension.